Provider Demographics
NPI:1942245600
Name:HERKEY, TAMMI (NP)
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:
Last Name:HERKEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7591 FERN AVE
Mailing Address - Street 2:SUITE 1501
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5750
Mailing Address - Country:US
Mailing Address - Phone:318-524-8032
Mailing Address - Fax:318-524-8033
Practice Address - Street 1:7591 FERN AVE
Practice Address - Street 2:SUITE 1501
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5750
Practice Address - Country:US
Practice Address - Phone:318-524-8032
Practice Address - Fax:318-524-8033
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LARN093892 AP03544363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1567183Medicaid
LA1567183Medicaid
LA3B462BD16Medicare PIN
LA3B462DU26Medicare PIN
LA3B462Medicare PIN